A world of difference.

17 03 2009

Two stories are currently dominating the news reports; Mid Staffordshire NHS Trust and Royal Bank of Scotland. Two stories of management pursuing goals deemed laudable, each receiving recognition within its own field of “success” only to have revealed the ultimate costs of those achievements.

Sir Fred Goodwin and the Board of the Royal Bank of Scotland are not the cause of the current financial “downturn”. There is no doubt that behaviour such as theirs contributed significantly to the failure of the Group and the subsequent, some would say required, major Government support of the Bank. Mr Goodwin received a knighthood, “for services to banking” and is currently involved in some discussion, shall we say, regarding the value of his pension/pay-off/ severance/reward from the company. Currently, the financial reward for his “services to banking” is to be paid probably tax free to a value that has as many digits as my mobile phone number. He has simply “retired”.

The management group of Mid Staffordshire NHS Trust strove through their actions in the three years leading up to 2008 to fulfill the Government standards regarding financial probity and clinical targets. The Trust was given the accolade of Foundation Status in recognition of its efforts in achieving those quality standards.  The “Annual Healthcare check” from the Healthcare Commision for 2007-8 can be found here. A snapshot of their performance is below.


Impressive eh?

Today, it is being widely reported that the Health Commision has found that the management pursuit and achievement of their stated goals was at the expense of clinical care. During this same three year period it is reported that there has been significant failures of management and clinical governance lead to unnecessary suffering and a significant number of deaths. How exactly this fits with the report issued last year is open to conjecture.

I’m sure we’re all pleased to hear that the senior managers of this Foundation Trust have “retired” too.

There’s so much I feel about this whole situation and its wider context that just breaks my heart.  Perhaps leaving it unsaid speaks louder than any words.


Your country needs you!

2 12 2008


At last, a voice speaking loudly what I’ve been thinking!

Prof Aidan Halligan has been variously employed as Consultant in Fetal Medicine through to Director of Clinical Governance for the NHS, Deputy Chief Medical Office for England and now Executive Chairman of Elision Health, an enterprise formed to accelerate reform and leadership in healthcare organisations.

In a series of articles in The British Journal of Healthcare Management he says,

“What has become clear is that the obstacles to transforming the NHS are not financial,structural or technical, but custom, tradition and convention. Structure and process, targets and regulation mean nothing unless reform genuinely engages with the feelings,thoughts and behaviours of staff.”

The misery frequently expressed in hospital coffee rooms around the land is that staff feel unable to deliver the care they want because of the constraints of budget and currently of delivering targets. Whilst achieving the targets have value in themselves; reducing waiting lists, reducing waiting time in Casualty etc it does not take account of or allow for delivery of the highest quality of care.

Prof Halligan believes this has lead to huge disenchantment within the caring professions and that what is required is

“a new and stronger voice: a voice that will be more concerned with promoting professional standards than with promoting professional status, and a voice that will be concerned with protecting the vulnerable and not the vote.”

This is Clinical Leadership.

He goes on in an article in the Health Service Journal to suggest that visiting many Trusts over a period of time,

” I noticed underlying themes of poor leadership, professional isolation, ineffective systems and processes, dis-empowerment and poor communication. The underlying team issues I saw included an “everyone knows” culture, active covering up, indecision, a disconnect between management and clinicians and a culture of fear.”

Sadly too many inspirational and influential leaders are numbed and inured to the effects of the current culture willing to simply go along with all that has happened because they no longer believe they can change anything.  I don’t believe there ever was a more perfect examples of a self fulfilling prophecy.We know that alongside quantity there must be quality of care.

What this country and our NHS needs now is effective and strong Clinical Leadership. It needs members of the caring professions to speak out, to influence and to begin to change things because we care, because it is our Health Service and because we know different.

Do you care? Do you see the problems? Then do something, anything, but do something about it; your country needs you.

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